# Alcohol as a Novel Trigger for Cannabis Hyperemesis Syndrome

## TL;DR

A 52-year-old man with chronic cannabis use developed severe vomiting episodes consistently triggered by alcohol, revealing alcohol as a new cause of a rare cannabis-related syndrome.

## Contribution

Identifies alcohol as a novel and specific trigger for Cannabis Hyperemesis Syndrome (CHS) through a case study.

## Key findings

- A single dose of alcohol consistently triggered CHS episodes in a chronic cannabis user.
- The patient's CHS episodes were associated with severe hyponatremia requiring ICU care.
- The case suggests alcohol use should be considered in CHS patient counseling and prevention strategies.

## Abstract

Cannabis hyperemesis syndrome (CHS) is a paradoxical condition occurring in chronic cannabis users, characterized by cyclic nausea, vomiting, and abdominal pain. While the primary trigger is cannabis itself, other precipitants remain poorly defined. We present the case of a 52-year-old male with recurrent CHS who experienced five distinct hyperemetic episodes, each occurring approximately one week after ingesting a single dose of alcohol. His most recent presentation was complicated by severe, life-threatening hyponatremia requiring intensive care unit management. Diagnostic workup confirmed CHS and excluded other pathologies. The consistent temporal pattern observed across multiple episodes suggests that a single dose of alcohol may be a novel and specific trigger for CHS. This case highlights a previously underreported precipitant and underscores the syndrome's potential for severe metabolic complications. Clinicians should consider inquiring about alcohol use in patients with recurrent CHS, as its identification could be pivotal for prevention strategies and patient counseling.